well being and care ultimately depends on individual and community action more so with the socio-economic and cultural problems faced by PALs. Such problems can be effectively solved when leprosy is incorporated into a PHC program.
Generally PHC programs include Mother and Child Health, family welfare, water and sanitation, control of malaria, tuberculosis. Integrating leprosy with these programs prvents the PAL from being singled out. A health worker visiting a family with children and leprosy patient does not face stigma of caring for leprosy patients as he/she may deal with a malnourished child or a malaria patient and he/she may examine all family members for leprosy and treat PAL.
Rehabilitation and improving self esteem for PALs need special attention and personalized care. The community around also has to be supportive. One of the principles of the PHC approach is that problems are reduced to a manageable unit-that is the community, unit of one or two thousand population. Rather than finding a solution for a mass problem, a village of two thousand population with a prevalence rate of 4/1000 will have eight persons needing treatment. Of these only two may need rehabilitation services in addition to education and medicines. The community knows each of them by name. If the local people shed their superstitions and deep-seated prejudices, they can be a tremendous force for the care of PALs. This calls for organisation of the communities and sharing adequate information repeatedly till the community internalizes the knowledge about leprosy. Health professionals therefore need to change the paradigm from being providers to enablers. They must be willing to enter into partnership with the community and the PALs.
In the seventies the Comprehensive Rural Health Project, Jamkhed (CRHP) began leprosy work by integrating it with mother and child health, nutrition and tuberculosis control. In addition to a health centre, a mobile health team visits every village in the project area regularly. The CRHP health team consists of Auxiliary Nurse Midwife (ANM), leprosy paramedical worker, social worker and initially doctor. All receive in service training as multipurpose workers and in the concept of working with people as enablers rather than providers. No one is singled out as a special leprosy worker, though each has responsibility according to their own fields in addition to supporting the other members of the team.(e.g. ANM for MCH; social worker for community organisation).
Local working groups are organized in each village unit, who are in a position to contact all the people in the community. Socially minded persons are identified from various groups and factions and organized into Farmer's Clubs (men's group) and Mahila Mandals (Women's Groups) around their self interest like income generation, agriculture. The majority of members are from the marginalized groups in each village. A local woman is selected as a Village Health Worker (VHW) by the village people or village organizations so they will be accepted and supported by the village. Various health topics including leprosy are discussed with these community organizations.
The VHWs have regular training in Maternal and Child Health, nutrition, and hygiene and they are taught to conduct normal deliveries and have a small medicine kit to treat common minor illnesses. They are also taught to examine, diagnose and follow up treatment of leprosy with the support of the CRHP team. They are especially helpful in the early detection of leprosy. They are present at all times in the village and have access to people.
